jan 2016 news letter FINAL


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Surgical Excellence through Advanced Robotics Jan 2016

Cutting Edge Surgery

From the CEO’s Desk Wishing a very Happy New Year to all of you involved with the fascinating field of Robotic Assisted Surgery! Vattikuti Technologies achieved the distinction of earning the Gold Standard Excellence for da Vinci servicing for the Second consecutive year at the Distributors Annual Summit held in Japan on 4th and 5th November. This is just an official recognition of the appreciation that I hear from Hospitals and Doctors all over the country about the effectiveness and speed of service provided by our system support team. Kudos to them! The last quarter saw the addition of da Vinci systems in major Hospitals in North and West India. Fortis Healthcare and Max Super Speciality Hospital in the NCR region and Jaslok Hospital in Mumbai became proud owners! With growth in the population of da Vinci systems and in order to service the surgeons and Hospitals better, we have added two new members to our Clinical Specialists team: Aditya Bidkar in Mumbai and Varun Luthra in Delhi. I look forward to meeting the growing Surgeon community at the Robotic Surgeons Conference being held next in New Delhi on 8th and 9th April 2016!

Gopal Chakravarthy CEO

Robotic Surgery - Media News

New Xi Robotic program at Fortis Hospital Gurgaon

We heartily welcome Dr. Rama Joshi to the elite Robotic surgeons club and wish a very successful GYNO Robotic program at Fortis, Gurgaon The ‘Gyn Oncology Robotic Program’ at Fortis Gurgaon, India kick started successfully on Saturday 2nd Jan’16. The mentor team of Prof. Dr. Somashekhar S P and his team member Dr. Ashwin KR from Manipal Hospital, Bangalore came down to Fortis Hospital Gurgaon to initiate the Robotic Gyn Onco program. Dr. Rama Joshi under the mentorship of Prof. Dr. Somashekhar successfully completed two complex Gyn Onco Robotic procedures, back to back on the same day.

New Robotic Surgeon Dr. Rama Joshi with her mentor Prof. Dr. Somashekhar S P

The mentor watches closely as the second surgery goes on

Robotic team at Fortis Gurgaon with mentors at the end of the day

da Vinci Xi Robotic Surgery at Delhi State Cancer Institute (DSCI)

DSCI OT Team for Robotic Surgery is all charged up post acquiring one of the first da Vinci Xi Robotic Surgery Systems in the region and the first Robotic Surgery System under the Delhi Govt. hospitals. The System has definitely brought convenience to patients through minimal invasive and practically blood-less surgery. As we know, surgery can be done by Open method or by minimal invasive Surgery (MIS) techniques which could be further categorized into laparoscopic surgery on two dimensional monitors or the newer generation innovative computer assisted three dimensional da Vinci Robotic Surgery to override limitations that arise out of laparoscopy. da Vinci robotic surgery, once mastered, has the ability of simulation of open surgical techniques along with technical ease of magnified stereoscopic clear vision, fine and precise dissection, suturing and perfect homeostasis in a large workspace provided by pneumo-peritoneum. Ever since it was conceptualized, minimal Invasive surgery has been very attractive for all abdomino-pelvic as well as chest surgeons and very luring for the patients too. There were obvious advantages as compared to open surgery as far as patient perspectives were taken into view. But what about surgeons? MIS by laparoscopy meant standing for long hours for surgeons with lot of challenges faced in several complex procedures that the surgeons wish to do to scale up their skills. Surgical manoeuvers in laparoscopy are limited due to straight rigid sticks allowing five degrees of freedom in counter-intuitive hand-eye co-ordination, with unsteady two dimensional image. Hence complex gynecological surgeries remained challenging with consequent low acceptance. In July 1997, FDA approved Computer assisted surgical system – the robot developed by Intuitive surgical known as the da Vinci Surgical system with the advantage of improved articulation with seven degrees of motion, scaled tremor free motions, true stereoscopic vision and improved ergonomics with technical advantage of allowing manoeuvers similar to open surgery. The system during this period, has undergone several upgradations for enhancing the scope of its application and safety, the latest version being the Xi model launched in 2014. DSCI was one of the first institution in India to have placed an order for the Xi System and we share our experience as beginner in computer assisted robotic surgery with the bliss of having performed twelve pan hysterectomy cases in different gynecological indications. After having practiced on the Si Simulator and now using the Xi System in our initial cases, we may comfortably say that this fourth generation Xi is very user friendly. It is easy to orient and dock with its laser cross lights. Open surgery hand movements can be replicated with ease as compared to Laparoscopy and there is less tug of war to keep the intestines away as compared to open surgery owing to the acute trendlenberg positioning of the patient. Surgery is controlled by the chief surgeon because camera control and vision, retraction of tissues and organs, along with performance of surgery with dissection and cautery can be performed through multitasking by using both hands and legs simultaneously.

da Vinci Xi Robotic Surgery at Delhi State Cancer Institute (DSCI)

Minimal invasive surgery becomes less dependent on assistant surgeons who can also be comfortably sitting and concentrating on the work assigned to them like gut retraction. Dissection is easier because of endowristed movements with 7 degrees of freedom that is much more than the limits of the human hand. In fact the whole surgery is performed in a large workspace created by the pneumoperitoneum aided by most innovative and advanced technology similar to that used in military and NASA services. There is also limited and controlled blood loss because of the excellent electrosurgery unit attached with the system and suturing is as simple as in open surgery. The da Vinci has the potential to teach a surgeon how to be good and precise in surgical movements and that surgery is an art akin to a complex space mission and that the surgeon needs to stay totally focused on the job. Thus the system has turned out to be highly alluring for the surgeons as well as the patients, with the surgical pleasure of performing complex procedure by a minimal invasive technique that helps escape long incisions, extensive abdominal layers and gut retractions to create workspace resulting in less tissue injury, less post operative pain, faster recovery and no ugly scars. The end beneficiaries of this magnificent surgical tool are both - the surgeons and the patients! With time the equipment and consumables will begin to get more economical and that will help go a long way in benefitting the common man to make optimum use of this efficient and patient-friendly surgical tool.

TORS Workshop at RGCI, Delhi

Dec 2015

Live workshop on “Transoral Robotic Surgery” was organized by Rajiv Gandhi Cancer Institute and Research center on 19th December 2015. Dr Chris Holsinger [Professor and Chief of Head and Neck Surgery at Stanford University Medical Center] was the Invited faculty for the workshop. He is one of the pioneers of TORS in the world. Two live surgeries were demonstrated to the audience by Dr Chris Holsinger and Dr Surender Dabas. Workshop was attended by more than 120 Head & Neck oncologist. There was interactive discussion about application of robotic surgery in head & neck cancer and its future in management of Head and Neck Cancers. This workshop was attended by surgeons from AIIMS, Medanta, SGRH, Apollo Delhi, Apollo Chennai & PGI Chandigarh. The workshop was well appreciated by all the delegates and faculty.

About Head & Neck Cancer & TORS: Head and Neck cancers represent a major international health problem, accounting for the fifth most common type and cause of cancer related deaths worldwide. In India Head and Neck cancers account for >30% of all tumor burden.

Dr Surender Dabas at the da Vinci console

Goals of treatment of H/N cancers 1. Cure of cancer 2. Cosmesis – preservation and restorations of functions

3. Function preservation – speech/ respiration/ swallowing 4. Prevent recurrence and 2nd primary cancers

Treatment options in Head and Neck cancers:

Open surgical approaches to the oropharynx can be associated with morbidities such as cosmetic deformity, malocclusion and dysphagia. Therefore, a trend toward using radiotherapy and concurrent chemotherapy as a primary modality in case of oropharyngeal cancer has been observed in the last few decades. However, evidence of a clear advantage of concurrent chemoradiotherapy over using combined treatment (primary surgery followed by radiotherapy or chemoradiotherapy) is still lacking, while toxicity of intensive chemoradiotherapy causing severe dysphagia with dependence on a gastrostomy tube has been well documented. In recent years, Transoral Robotic Surgery (TORS) has been used for the removal of pharyngeal and laryngeal cancers with the objective to improve functional and aesthetic outcomes without worsening survival. Based on reports in transoral laser surgery (TOLS), the benefits of the transoral approach to the pharyngo-laryngeal lumen are well known.

TORS Workshop at RGCI, Delhi

Dec 2015

For those not familiar with the term ‘robotic surgery’ - it is performed utilizing the da Vinci surgical system. The surgeon sits at the console and controls micromanipulators, which in turn are connected to a robotic cart at the patient’s bedside. In TORS, three arms are routinely utilized. The central arm has a double video endoscope with high-quality video that gives the surgeon a three-dimensional view of the operative field via the console. The two other arms carry interchangeable instruments (approximately 5mm wide and 2 feet long) with miniaturized tools on the end that mimic standard surgical instruments (i.e. electrocautery, pickups, etc.). The tips of the double-video endoscope and the instrument arms are inserted transorally and the assistant sits at the bedside to aid with suctioning and retraction. The tips of these robotic surgical instruments are also ‘wristed’, so when surgeons move their wrist and hands at the console, the entire motion is scaled down to the miniaturized ‘robotic’ instruments, with benefits such as tremor filtration.

ADVANTAGE OF TORS: Technical advantages: Clearer and wider view of the surgical field Better 3D visualization of structures Access to the tumour via a smaller approach Use of miniaturized tools Tremor filtration Reaches "blind corners" of the pharyngo-laryngeal complex

INDICATIONS OF TORS: Transoral robotic surgery can be done in naïve patients as well as for salvage in residual or recurrent tumors post CT/RT. 1. T1/ T2 oropharyngeal cancers 2. Selected T3 oropharyngeal cancers 3. T1/ T2 supraglottic cancers 4. T1/T2 hypopharyngeal cancers 5. Pharapharyngeal space tumors

OUR EXPERIENCE AT RGCI We started our Transoral Robotic Surgery program in March 2013. We are doing TORS in naïve patients as well as salvage treatment after failure of CT/RT. Till today we have done 220 TORS procedures.

Functional advantages: Avoid disfiguring mandubulotomy Reduces the need of adjuvant radiation/ or chemotherapy Avoid tracheostomy/ gastrostomy Improves the return to normal speech and swallowing Less blood loss & postoperative pain Minimal scarring Reduced risk of wound infection Shorter hospital stay & recovery time

CONTRAINDICATIONS OF TORS: 1. Reduced mouth opening < 1.5 cm 2. Incomplete lesion visualization 3. Mandible involvement 4. Internal carotid artery involvement 5. Prevertebral fascia involvement 6. Tumors involving >50% of base of tongue or the posterior pharyngeal wall

Dr. Jagdishwar Goud Gajagowni earns Award in Korea

Dr Jagdishwar Goud Gajagowni is the Head Of Surgical Oncology and Clinical Director, Robotic Oncosurgery at Krishna Institute of Medical Sciences (KIMS). Recently, he was recognized at the 10th Annual International Robotic Surgery Live 2015 event in Seoul, South Korea where he got the best paper recognition for Esophagectomy at Severance Hospital, Yonsei, Seoul, amongst a noted group of talented Koreans and Japanese.

- See more at: http://vfrsi.vattikutifoundation.com/jagdishwar-goud-gajagowni-earns-award-in-korea

Dr. Jagdishwar Goud - Outstanding Poster Award

Dr. Jagdishwar Goud - Outstanding Poster Award

“Dynamics of Surgical Innovation” JIPMER, Pondicherry

Vattikuti Technologies organized a Guest Lecture by Dr. Mahendra Bhandari, CEO th Vattikuti Foundation on 24 November 2015 at JIPMER, Pondicherry. Around 80 doctors attended this event. Dr.Bhandari made a presentation on the history of Robotic Surgery and Vattikuti’s commitment to make Robotic Surgery Programs a grand success across the globe. He highlighted the benefits and features of a Robotic Program with da Vinci systems - like better vision, endo-wrist movement, etc. and also dealt in detail about the spectrum of benefits from nerve-sparing surgery to Kidney transplant. He stressed on the dynamic field of urology and advancing technology contributing to the growth on a daily basis. He also emphasized on the benefits of starting a Robotic Program in JIPMER, which majorly caters to the middle and lower strata of the society. Dr. Bhandari having started the Urology program at JIPMER was very nostalgic about the Department of Urology there and this was equally acknowledged by all the senior members of the Institute. The surgeons were also eager to resolve their queries through Dr.Bhandari.

They arranged for a visit to their Urology Department which helped facilitate an interaction with the faculty members. Later Dr.Balachander, Medical Superintendent organized a meeting with the multidisciplinary “Robotic Surgery Committee” in the board room to discuss on initiating a Robotic Surgery Program in their institute. This meeting was presided by Dr.S.C.Parija, Director, JIPMER. They thanked the dignitaries from Vattikuti Technologies, Mr. Gopal Chakravarthy, CEO and Mr. Vasudevan, Regional Manager for system sales in South for organizing this meeting and are looking forward for the organization’s support to begin a da Vinci robotic program in this prestigious institution.

Media News Indiatimes|The Times of India|The Economic Times| Gurgaon: Da Vinci Xi robots perform among the first of its kind surgery GURGAON: A 35-year old patient from Republic of Congo, who was suffering from Yousuf's Syndrome, has undergone a surgery with Da Vinci Xi system, one of the most advanced robotic surgical technology for performing minimal invasive surgery. This is reportedly one of the first such surgeries in India. The system allows a doctor to perform a surgery with pinpoint accuracy and little damage to surrounding tissues. The benefits of robotic surgery include a minimally invasive approach, faster return to daily activities, fewer complications, and shorter hospital stay with reduced hospitalization costs. Yousuf's Syndrome is a condition, where due to complications from previous caesarean sections, an anomalous fistulous communication had formed between the uterus and the urinary bladder. This had led to menstrual bleeding draining into the bladder, leading to cyclical hematuria and repeated infections. The patient, therefore, occasionally had urinary incontinence, as urine would flow into the uterus and leak out. "Previous medical consultations and reviews had all pointed towards a hysterectomy. However, she was not willing to undergo the procedure for removal of the uterus. With our robotic surgery programme, we not only managed to separate the fistula that had formed between the two organs, but also saved her from a hysterectomy. Surgeons at FMRI are currently utilizing advanced minimally invasive surgical techniques for all surgical specialties," said Dr Sanjay Gogoi, Director, Urology and Renal Transplants at Fortis Hospital. Talking about the benefits of Da Vinci Xi system, Dr. Gogoi said, "The device allows high definition 3D imaging, allowing surgeons to conduct complicated procedures with relative ease. The procedure involves using wristed instruments that bend and rotate far beyond the abilities of the human hand. Moreover, the tremor filtration and intuitive motion technologies allow the surgeons to operate with steady natural motion with the comforts of sitting on an easy chair."

15-Years of Robotic Surgery at VUI [Vattikuti Urology Institute]

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Congratulations to Dr.Mani Menon and his team for the 15 anniversary of the robotic surgery program at VUI – Henry Ford hospital, Detroit, Michigan, USA The Vattikuti Urology Institute (VUI) at the Henry Ford Hospital in Detroit, Michigan is a clinical and research center for urological care. The VUI is notable for being the first institute to establish robotic surgery as a treatment for patients with prostate cancer. To date, the VUI has performed more than 5,000 robotic procedures. Ranked consistently high by U.S. News and World Report, VUI is also one of the largest and most active urology departments in the United States, with nearly 50,000 patients annually from all 50 states and nearly 25 countries.

Dr. Mani Menon with VUI and OHIO STATE UNIVERSITY CADAVER LAB STAFF (Also seen: VF CEO Dr. Mahendra Bhandari, Dr. Akshay Sood and DR. Wooji Jeong)

The VUI & Robotic Surgery The Vattikuti Urology Institute is considered a pioneering institute in what has been called a “medical revolution”: the use of robotics for the surgical removal of the prostate and other urological procedures. There is lesser trauma and pain, shorter hospital stays, and minor scarring for the patient undergoing minimally invasive robotic surgery. Robotic Surgeons at the VUI are equipped with the da Vinci robotic surgery system which increases surgical precision that helps detect and preserve delicate nerves and muscle that surround tissues. VUI's surgeons have developed and practice a variety of minimally invasive procedures utilizing robots. These surgeries include: "Vattikuti Institute Prostatectomy", Robotic Partial Nephrectomy, Robotic Radical Nephrectomy, Robotic Pyeloplasty, Robotic Nephroureterectomy, Robotic Pyelolithotomy, Robotic Renal Cyst Decortication

The "Vattikuti Institute Prostatectomy" The Vattikuti Institute Prostatectomy (VIP) is a robotic procedure developed by the VUI. This is the institute's preferred procedure for the removal of the prostate. Dr. Mani Menon had developed the VIP procedure and under his guidance, urologists at the VUI were the first in the world to perform using the da Vinci robot.

- See more at: http://vfrsi.vattikutifoundation.com/15-years-of-robotic-surgery-at-the-vui-two-different-perspectives

DR. KHURSHID GURU Director of Robotic Surgery Roswell Park Cancer Institute, Buffalo, New York

International News

Reflections on the 15th Anniversary of the Robot Assisted Radical Prostatectomy at Vattikuti Urology Institute (VUI)

DR. KHURSHID GURU

DR. KHURSHID GURU with DR. MANI MENON

The Vattikuti Foundation continues to recognize the Fifteenth Anniversary of Dr. Mani Menon’s first Robot Assisted Radical Prostatectomy. Professor Khurshid Guru is a former Vattikuti Urology Institute Resident. His reflections at the Centennial Celebration of VUI, Henry Ford Hospital, Detroit: “One of the most important things is that when the robotic prostate revolution started at Henry Ford, we were junior Residents and one of the issues was that- everybody wanted to do prostatectomies- and one of my goals was to learn how to do cystectomies. Dr Menon had the vision to send me to Mansoura, which is one of the world’s most famous bladder cancer centers in Egypt, with some of the finest surgeons. After that, he brought me back and gave me strong training at Henry Ford. The amazing part is that- I was able to kind of put these two skills together to start a bladder program at Roswell Park Cancer Institute. The rest is history”. “One of the most amazing and innovating- and kind of courageous thing- was that Dr. Menon went to Egypt with the robot. We had- never ever dared to take technology to a new place, to some of the finest bladder surgeons and kind of tried the procedure with them and get their insights. And that vision- almost more than a decade back, of taking the robot, and making the most critical surgeons for this procedure look over your shoulder, while you are developing your technique, I think was kind of a feat in itself. It was definitely some of the best open surgeons, with new technology, and with a visionary, together. And they built this whole idea of using the robot for bladder cancer”. Basically the proof of the pudding is in what you see around at VUI. Fifteen years ago, what he did was innovating, new, risky and even kind of scary. He set the bar for prostatectomy high. If you look around the world, a lot of people have benefitted with this technique that come out of Henry Ford Hospital. The quality of this procedure and the results are remarkably better and consistent with a lot of surgeons than what it was fifteen years back when you only had a few master surgeons in a few areas. Now this has gone- like they say- viral and that too with very good results

© 2015 Vattikuti Foundation

- See more at: http://vfrsi.vattikutifoundation.com/reflections-on-the-15th-anniversary-of-the-robot-assisted-radical-prostatectomy

Robotic Surgery - Media News

Vattikuti Foundation to Award Scholarships to Robotic Surgeons Council of India

RSC 2016

Vattikuti Foundation will be awarding up to nine scholarships during the Robotic Surgeons Council of India meeting to be held at Indraprastha Apollo Hospital, Delhi on 8th & 9th April, 2016. e-mail your entries to: [email protected] Remember the deadline is 1st February, 2016 - See more at: http://vfrsi.vattikutifoundation.com

Awards & Recognition Vattikuti Technologies Recognized as Gold Standard for Excellence in da Vinci Service at the 5 Annual Intutive Surgical Distributors Summit Nov 4 & 5 2015, Osaka, Japan th

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